Drug Disposal Questions

Once in a while I’ll get a few good questions that I think should be public knowledge. In fact, I even made its very own category for it! I only try to pick questions that a lot of people ask, and something that I can make funny and entertaining to read. As always members of the profession can chime in via comments to add onto the mayhem.

I have never worked in a pharmacy, so I have to ask…
Are there really THAT MANY people who are “strung out” on Vicodin (and
other opioids)? Judging by what I’ve read on this board, it sounds like
Vicodin prescriptions make up like 75% of all the Rxs filled! Is it really
this big of a problem? Soma, too?

Short Answer: Yes
Long Answer: Oh fuck yes. You are right, depending on your location, you’ll see the number 1 Rx based on pill volume for most community/retail settings will either be Vicodin/ES, Soma, Tyl#3, or Valium. Hands down no question about it. It might not be #1 (I think glyburide is up there pretty good, just because EVERYONE is on #120/month), but i’ll bet your ass the goodies are in the top 5.
Now strung out. Lets see what stories I have:

Phone calls are the best. They sit there in silence, make no sense as they call in their vicodin refills early, and have zero memory of doing so. They’ll call back in 20 min asking the exact same thing. You can tell from their voice that they are gone to Vicodin-Town.

When they come into the store, they have that glassy not-there look. Take someone who is really drunk, remove the smell, and have them (and their 5 screaming children) wander up to your counter asking for a refill on an Rx they picked up yesterday.
Next question, YOU! The blonde with the gynormous boobies in the back!

You bring up something I have been wanting to ask but didn’t want to
broach…
Now that I am minus a brain tumor, I am off all of my pain meds [Fentanyl
and Morphine]. What do I do with the extra patches? I haven’t known who to
trust to hand them over, and you know why.
Should I turn them in to the pharmacist, really? (Not questioning your
judgement, just asking for reassurance)

And your well endowed friend next to you:

You say that your patients/clients can return unused medications to be
destroyed, do most pharmacies do this? If not, what is the best way to
dispose of old medication? Sorry for the questions, my grandmother died in
April and my family hasn’t done anything with all her medicine yet.

If ever you have medication that you want destroyed, you should bring it back to the pharmacy it came from. In the fentanyl patch case, yes, you should return it to the pharmacy. We’re not scummy cops who pocket guns and drugs from raids to use/bring home to their kids. We actually care about our license, and our profession so we will dispose of the unused (or used) patches. Especially with the 100mcg fentanyl patches you want to make sure you take them and hand them to the pharmacist directly for disposal. Cutting them up and throwing them away can have really bad results, so dont do it.
The same goes for unused pills that you bring back. To make it sound official we say that we “Have procedures in place to dispose of all dangerous drugs in an environmentally safe fashion”. Honestly all we really do is dump the pills into a huge sharps container, and the nice lady who does our outdated drug returns takes it to a place where its incinerated. No, they are not dumped into a giant toilet and flushed. Flushing stuff like pills really isn’t a good idea anyways, because stuff like Klor-Con tends to stick together worst than a post-thanksgiving turd and will plug your toilet. Yes, personal experience talking here (the pills, and the thanksgiving turd).
I’m pretty much free to answer any question you may have about pharmacy, life, etc. If you want liberal political bantering, go to the DrugNazi’s. This is pharmacy-only (which I’m sure you guys appreciate). You can email me at druglord/at/theangrypharmacist/dooooot/com (Stupid spambots). Now I will choose what questions I pick based upon how angry and entertaining I can make the responses, so don’t get your feelings hurt if I don’t answer your question.
Oh, and happy 1st to all the pharmacists out there. I hope today wasn’t too killer.

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16 thoughts on “Drug Disposal Questions”

On the disposal note…
I get a kick of the new RCRA regulations and the public awareness of how to dispose of drugs now-a-days…. You can’t put it down the toilet anymore! It’s going to harm the water supply….I’ve got news for those blithering idiots… Where do you think the unmetabolized, or hell, even metabolized drugs that you ingested hours or days ago are going?! Down the toilet when you take a piss or dump!!!!! So it’s pointless to be concerned about dumping a drug down the toilet when your body is going to do it anyway!!!!!

doxycycline is #1 round these parts. Vicodin ES is #2.
I guess they need to deal with Lyme disease first… their love of hydrocodone comes second.
(i love it when i hear “MAKE SURE IT’S THE ‘WATSON’ GENERIC VICODIN.. THE OTHER ONES DONT WORK!)

Not every pharmacy will accept meds from patients to be destroyed (probably because we are not required to). I work for CVS and we don’t take meds back that patients no longer want. In pharmacy school, we are taught to tell patients to destroy meds in certain ways or send them to pharmacies that accept them. In the case of the duragesic patch, we are supposed to tell patients to fold them in half (sticky sides together) and flush them down the drain. Even used patches should be destroyed in this manner because of the amount of drug left in the patch could still kill a young child if they got a hold of it. (and then we would have another law suit against the drug company, pharmacist, and MD because someone was stupid enough to let their children get a hold of some)

In February the EPA and the DHHS put out new guidelines for disposing of unused drugs. It seems that Rx and OTC drugs are being found in alarming levels in water supplies across the country, giving you another reason not to flush everything. Basically, the new plan is this: crush up tablets and mix with kitty litter or something else inedible, put in a plastic bag, and toss. Alternatively, we pharmacists are still happy to take them back if you prefer. Or sell them on the street. Whichever.
link: http://whitehousedrugpolicy.gov/drugfact/factsht/proper_disposal.html

i actually don’t see as much vicodin, valium, and tylenol #3 as you seem to. our number one script is oxycontin, specifically the 80 mg’s. this is primarily thanks to a quack of a doctor that handed out oxycontin scripts left and right, and you didn’t even need an appointment for him to write you one. he’s since had his license revoked, but we have a lot of people who are now hooked on them and whose already existing addictions have become worse, thanks to him.

In reference to the Vicodin question: My favorite Vicodin patient is the one that calls in and you tell them that it is too early and insurance won’t pay for it. They tell you they are leaving for vacation. I want this persons job because they must have 12 weeks of vacation a year because every month they go on vacation. They say they will pay cash. To this I respond I will need to call your Dr. to Ok an early refill. The doctor denies it. Call the patient back and tell them the bad news. The next week who comes in to pick up there Vicodin, the same globe trotting person who is out of town. Come the following month same scenario. It all adds up to lots of wasted time for the pharmacy and doctors office. After this happening every month I need a vacation

Awesome blog, man!
I just wanted you to know that you have made it on my blogroll and I will be reading regularly!
By the way, I HATE opioids because they stop my gut up something fierce. Then the saying, “shit a brick” doesn’t do my pain a week later justice. More like “shit the Taj Mahal!”

TO Whoever monitors and actually reads these posts…Make sure the angry Pharmacist gets this!!! I really dont have anything to add to your current Posts…But i def agree with all of it…This is some funny “but so damn true” stuff youve got going on in your site. Anyway the reason for this post is find out what your store name, where your located, and what pharmacy software are you using? Im actually an Installer/Trainer of 7 years for Computer-Rx based out of Oklahoma City, OK, And i can assure you that Most of our Installers Get a kick out of your site because we See what you guys and gals go through on a daily basis. So im done babbling and If your curious about a new system then reply! Being the angry pharmacist im assuming youd have the Balls to at least reply and tell me you read this!!! Anyway keep up the great work!
Eric Vandeventer
11825 S. Portland
Oklahoma City, Ok 73170ericv@computer-rx.net
Computer-Rx Installation and Training

The whole water supply issue is weak…. Drugs are still going to be eliminated from your body in urine and feces…so it doesn’t matter if people stop flushing drugs down the toilet!!! They’re still going to get into the water supply. That’s what treatment plants are for.

DON’T put returned opioids in the sharps box (unless your sharps box is picked up by an incineration service.) Then you get addicts going through sharps boxes in the community looking for both syringes AND drugs at the same time.
Our hospital pharm uses a big coffee grinder and grinds EVERYTHING en masse, throws in naltrexone as a matter of course (and lets that be known), mixes that with floor leveling compound (no kidding), and disposes of the “bricks.”

Actually, the reason drugs are in the water supply is that waste water treatment plants are NOT set up to clear these out of the water. Everything cycles through, sorry, but it’s so. Bottom line, we eliminate drugs to wwtp, it does NOT eliminate drugs, sludge from such treatment plants is spread on farmer’s fields (no, I’m not making this up), it rains, and bingo zippy, meds are back in the water system.
Don’t flush meds, please. Any of them. If I were a man, I’d be very, very worried about all that estrogen in the system since birth control came into being.

Who gives a crap what you’re blabbing on about? You have a job, so do it. Don’t worry about who needs what it is not your place to give a shit. If it weren’t for scripts and doctors you wouldn’t have a job. These medicines help people with chronic pain. I injured my neck and need a refill so I am getting one from my doctor. What. Are you gonna whine about me being on MEDICAID too?! Bitch. You’re just jealous you can’t relax and have a nice high and not be stressed out. Go get some sex maybe you’ll feel better.